The present invention relates generally to a device for assisting with a medical procedure and, more specifically, to a device that may be directly actuated by a surgeon, or used in conjunction with a robotic surgery system.
Minimally invasive surgical procedures have gained increased acceptance within the medical community. These procedures, sometimes referred to as laparoscopic, endoscopic, arthroscopic or keyhole surgery for example, use several small incisions to provide the surgeon access to the areas of the patient requiring attention. These incisions are small, typically on the order of 0.5 cm-1.5 cm. The surgeon uses a camera to view the surgical area and control tools or implements during the operation. These implements include tools such as cameras, forceps, cutters or dissectors for example. A device known as a trocar is often used in the incision during the procedure to allow the insertion and removal of the implements during the surgery. Minimally invasive procedures provide a number of benefits in reducing risks of infection and increasing the patient's time period for recovery.
The minimally invasive procedures may be performed either manually or through some type of robotic apparatus. In a manual procedure, the surgeon directly holds the surgical implement during the surgery. This allows the surgeon to act directly through the tool to perform the necessary repairs to the patient. One advantage of this method is that the surgeon receives some tactile feedback by holding the tool. Manual procedures also provide additional advantages in cost, setup time and speed of operation.
Minimally invasive surgical procedures are also performed using robotic systems. The robotic apparatus has two discrete and usually separate portions, a control center for the surgeon and a surgical machine adjacent the operating table. The surgeon views the patient through a video display that can be actively manipulated by the surgeon to change or enhance the view, such as by changing angles or magnifying critical areas for example. Sensors are attached to the surgeon by a sleeve over the surgeon's arm, and/or with gloves or some type of gripper. A computer system receives electrical signals from the sensors and translates them into movements of motors and linkages on the surgical machine. This allows surgical instruments to move in response and mimic the movements performed by the surgeon. An assistance team provides support to the surgeon during the procedure and performs tasks such as preparing the patient, changing instruments and caring for the patient when the procedure is complete. Robotic surgical apparatus provide a number of advantages. While the control center and the surgical machine are typically located proximate to each other, this does not necessarily need to be the case. The control center could be located at a center location where specialized medical personnel reside, while the surgical machine may be located in a remote village, or in the military application, next to a battlefield for example. This allows for highly complex surgical procedures to be performed over a wide area with only a few doctors. Further, since the robotic surgical machine provides a high degree of control and precision, the robotic system can also facilitate procedures that typically cannot be performed manually.
Still other systems have been proposed that combine the cost and tactile feedback benefits of manual endoscopic procedures with the precision and control of the robotic surgical machine. These systems, sometimes referred to as direct drive systems, use a rail platform and a guide sheath that accepts multiple endoscopic instruments. The system is mounted to the operating table, or adjacent to on a freestanding frame, in close proximity to the patient. Handles or actuators are then provided to allow the surgeon control of the implements. The handles are directly coupled via cables and linkages to the endoscopic instruments. This allows the surgeon to directly manipulate the instruments and since there is a physical connection (e.g. no computer) between the patient and the surgeon, a limited amount of tactile feedback is transmitted to the surgeon.
It should be appreciated that no matter what type of system is used, size is an important parameter for endoscopic instruments. The smaller the instrument, the smaller the incision and the lower the risk of infection. Further, the smaller the instrument, the more instruments can be fitted within a standard size incision. Advantages can be gained by increasing the number of instruments since the need to change instruments during the procedure will be reduced. This reduces the chances of the patient being inadvertently injured during the withdrawal or insertion of the instruments.
Typically, endoscopic instruments have an over all length of 30 cm-150 cm with an instrument having a length of 4 mm-5 mm and a diameter of 2 mm-4 mm. In the case of instruments such as forceps, scissors, dissectors, or graspers for example, the instrument also needs to be operated between an open and closed position. These instruments also need to articulate about two axes, rotating to an angle relative to the axis of the instrument, and also rotating about the axis of the instrument. This functionality is performed by arrangements utilizing multiple pulleys and cables and/or push rods. It should be appreciated that the mechanisms required to both operate and articulate instrument tend to increase the size of the instrument.
Accordingly, while existing surgical tools are suitable for their intended purposes, there still remains a need for improvements. In particular, improvements are needed regarding the operation of the surgical tools that are operated between positions during the surgical procedure, while also reducing the size and complexity of the surgical tool.